What the President’s Healthcare Plan Means for Virginians

What the President’s Healthcare Plan Means for Virginians

Virginia’s Congressional Delegation Offers Mixed Reviews on TrumpCare; Comstock Undecided.

After years of promising to repeal and replace the Affordable Care Act (ACA), Congressional Republicans along with President Donald Trump have released a plan, the American Healthcare Act, that is projected to cut $337 billion from the federal budget over the next 10 years but also leave 24 million more uninsured in that same period. Those figures, coming from the nonpartisan Congressional Budget Office (CBO), have members of both parties lobbing criticisms.

The GOP, with control of the White House, Senate and House of Representatives for the first time in more than 10 years, has political control but may not have the votes to dictate the fate of the bill. The mood of Virginia’s members of Congress may be an early indicator of where Loudoun County and the rest of the nation stand on the pitched battle to “repeal and replace”.

Goodbye to Obamacare (in Part)

The Affordable Care Act, enacted by a Democrat-controlled Senate and House and signed into law by former President Barack Obama in 2010, brought massive changes to the nation’s healthcare system. Through an individual mandate ordering all Americans to obtain health insurance or pay a fine, as well as government subsidies to help afford coverage, millions more Americans obtained insurance coverage in following years. The ACA, also known as Obamacare, also brought many critics that pointed to its flaws, including high premiums and limited options for many. Republicans, widely citing these concerns as well as the federally-mandated approach to healthcare, took control of the House in 2011, the Senate in 2015 and have been pledging to overturn ACA ever since.

According to figures from House Republicans, premiums have increased by an average of 25 percent this year, nearly one of three U.S. counties have only one insurer offering plans on their state’s Obamacare exchange, and 34 percent fewer doctors and other health care providers accept Obamacare insurance compared to private insurance. While opposing the ACA, Republicans have mostly said they wanted to keep popular parts of the plan like the ability for children to stay on their parent’s plan until age 26 and the mandate that insurers can’t deny coverage because of a pre-existing condition. Trump has also said he wants to ensure all Americans, a high bar.

The new GOP bill would eliminate the ACA’s premium subsidies and replace them with new, age-based tax credits ranging from $2,000 to $14,000 to help low and middle-income individuals and families who don’t receive insurance through work or a government program pay for coverage, including for dependents up to 26. These credits don’t take into account where someone lives or income, although they start to phase out for individuals earning over $75,000. The CBO says this help will reduce the federal budget by $337 billion and premiums by around 10 percent for single policyholders by 2026.

The bill also continues to prohibits insurers from charging more or denying coverage for pre-existing conditions. Though it eliminates the mandate and subsequent fine for not having coverage, it would allow surcharges for one year when consumers lack continuous coverage. Anyone without insurance for 63 days would be subject to a 30% premium surcharge, which critics have called a “death spiral” since healthy individuals would not have enough incentive to buy insurance.

What’s getting the most attention is the CBO’s finding that the bill reduce the number of Americans with health insurance by as much as 24 million, and in some cases will raise health care costs for patients, particularly the elderly. “Although average premiums would increase prior to 2020 and decrease starting in 2020,” the CBO report says, “changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules.” The report says that a 64-year-old making $26,500 in 2026 would pay $1,700 a year for coverage under subsides from the current law. Under the AHA, which allows for greater charges for elderly patients than Obamacare, that annual premium would be $14,600, due to the reduced tax credit.

Other parts of the bill include tax cuts for wealthy Americans who funded much of the ACA.  It also stops funding 501(c) (3) organizations like Planned Parenthood that provides abortions in cases other than rape, incest, or when the mother’s life is endangered and that received more than $350 million in federal and state Medicaid funding in fiscal year 2014.

Another major part of the ACA was the option for states to enroll in Medicaid expansion. Virginia was one of 19 states not to enroll, and the Commonwealth’s Republican-controlled House of Delegates and Senate have continued to thwart efforts by Democratic Gov. Terry McAuliffe and others to do so. Still, Virginia and its several hundred thousand beneficiaries, will be impacted by the significant restructuring of the program that will cut funding and enact caps to coverage. Instead of the current system that covers all costs for low-income families and the disabled, the AHA offers “block grants”, lump sums that states then disperse for healthcare costs. In 2020, Medicaid is capped on a per capita basis.

Virginia Republicans Divided, Comstock Undecided

Virginia Rep. Rob Wittman (R-5th) is one of several in the GOP to come out against the bill. Considered a moderate, his opposition carries significant weight if other centrists follow suite. Many more conservative Republicans in the House, including Virginia’s Rep. Dave Brat (R-7th), have opposed the approach now championed by Trump and House Speaker Paul Ryan. Assuming a monolithic Democrat voting bloc in Congress, that leaves prospects for passing the bill in its current form at best uncertain.

That uncertainty doesn’t mean Republicans locally and nationwide have abandoned the bill.

“We know Obamacare is a disaster. The law is collapsing and doing nothing is not an option. That is not leadership,” said Virginia’s Rep. Scott Taylor (R-2nd) in an address defending the AHA on behalf of the Republican Party of Virginia.

“We will protect those with preexisting conditions, we will work help those who can’t help themselves, work to get more access and more people covered, keep in mind there are many today who have no coverage under the ACA because they can not afford it,” Taylor said. “There are many people and families out there who are making tough decisions because their premiums have skyrocketed under Obamacare.”

Meanwhile, Virginia’s Rep. Barbara Comstock (R-10th), whose district includes all of Loudoun County, has proposed Obamacare repeal and replacement but has not weighed in publicly on what president Trump and Ryan have proposed.

“The legislation is a work in progress, and we continue to talk with constituents, medical professionals, and other stakeholders on their concerns and needed reforms.” said Jeff Marschner, Comstock’s Deputy Chief of Staff.

Comstock has touted her close relationship with Ryan and is widely considered a moderate voice on the Hill, so her position could likewise have a major impact on the bill.

Virginia Democrats United in Opposition

McAuliffe joined both of Virginia’s senators in vocal opposition to the changes in the new bill, citing concerns over costs, coverage and cuts to the program.

“Republicans had seven years to pull together a plan, and now they insist on rushing to pass a bill without taking the time to analyze the cost and impact on the American people,” said Sen. Tim Kaine in a statement. “Trumpcare doesn’t fix health care, it’s just a tax cut for the very wealthy. We cannot walk back the years of progress we have already made to ensure that every American has access to quality, affordable care.

“Instead of improving what we have, Trumpcare seems designed to cover fewer Americans, and makes that coverage less generous and less affordable,” said Sen. Mark Warner in a statement.

What Next?

The Republican House leadership is trying to advance the bill quickly.  It passed by the House Energy and Commerce Committee on a 31-23 vote and the Ways and Means Committee on a 23-16 vote on March 9.  It will be heard by the House Budget Committee on March 16 before reaching the House floor for a vote, which could come as early as next week. Should the bill pass the House, it will go on to the Senate, where Republicans hold a slim 52-48 majority.

Senate Majority Leader Mitch McConnell  said should the bill reach his chamber, it will go directly to debate and subsequent vote before the entire Senate. Should the bill pass both chambers, it would then go to the president to be signed into law.

The White House hopes to have all this completed by early April, while Virginian’s and all Americans are still trying to understand what it all means for them.

Update 3/15 11:04 p.m.: The story has been updated to reflect the statement by Marschner